Managing Multiple Sclerosis in Patients with Immunosenescence and No Disease Activity Off Therapy

Assessment and Management

Patients over 55 years of age with stable disease may be considered for treatment discontinuation, as the benefits of continuing immunosuppressive therapy may be outweighed by increased risks of infections and other adverse effects, according to the National Institute of Neurological Disorders and Stroke 1
Regular brain MRI scans are essential for monitoring disease progression, and follow-up scans should include contrast-enhanced T1-weighted and T2-weighted sequences, as recommended by the American Academy of Neurology 2
For patients who discontinue therapy, brain MRI should be performed at least annually, and more frequent monitoring (every 3-4 months) may be appropriate initially after discontinuation, as suggested by the Multiple Sclerosis Association of America 2
The European Committee for Treatment and Research in Multiple Sclerosis recommends that disease stability off therapy should be confirmed with both clinical and MRI assessments before making treatment decisions 2
Younger patients (<45 years) with short disease duration (<10 years) or history of highly active disease before stabilization may be considered for continued current therapy, according to the National Multiple Sclerosis Society 1